April 17 2020
Tendon pain is one of the most common presentations to physiotherapy clinics across the globe. There is a lot of information around about what the best treatments are and as usual, we are going to try and simplify the whole thing for you to help you manage your tendon issue.
A WORD ON TERMINOLOGY
When you see a health professional about your tendon problem or when you read about it with the Interwebs, you may find that there are a lot of different terms for tendon pain. Terms like;
Tendonitis, tendinosis, tendinopathy, tenosynovitis, paratenonitis, tendon tear, tendon rupture or (our favourite) a BL@#%Y SORE TENDON!!!
This can all get very confusing and the take home message here is that these are essentially interchangeable terms for the same thing, tendon pain. The medical terminology has changed over time as researchers have learned more about tendons and how to treat them effectively. If you are academically minded and interested, the most commonly used term is tendinopathy.
WHAT ARE TENDONS AND WHAT DO THEY DO?
Tendons are the structures that connect our muscles and bones together and help transmit the forces our muscle exert on our bones in order to produce locomotion (cue Kylie Minogue …..!)
As a result, tendons have to act like springs and stretch and absorb force coming without losing the energy created to propel us higher, longer and faster along the ground or in the air. There are a number of different forces that tendons are put under, namely;
- Compressive – when tendons are compressed against the bony structures that they attach to (e.g. below your kneecap when you squat in preparing to jump)
- Tensile – when the attachments of the tendon and muscle are pulled apart like a spring (e.g. the Achilles tendon when you squat in preparation for jumping)
- Shear/friction – when the tendon rubs or shears against a bony prominence (e.g. in your shoulder with repetitive tasks)
- Combination – lots of movements we do create a combination of the above mentioned loads (e.g. in jumping you get some compressive load and some tensile load in the patella and Achilles tendons)
One of the most important this to understand about tendons is that they LOVE to have all of these loads put through them. They are thick and robust structures that can tolerate a lot of energy and work put into them across your entire lifespan. What they don’t like, and one of the main reasons they get painful, is when the amount of load that gets put through them changes quickly.
Commonly, people either take a break from exercise or activity and build back up too quickly or they get a sudden bout of motivation and increase their activity levels too much and their tendons complain
In terms of tendon pain and injury, these get split into two types;
ACUTE INJURY – This involves a distinct incident where a person is injured. The damage can be varied from an irritation of the tendon involving some pain and loss of function to a tendon rupture. Have a look at this example of an NFL player who lands on his R) leg and as the Achilles tendon absorbs the force and he tries to push off and sprint, something goes … TWANG!!
TENDINOPATHY – All other tendon injuries and pain fall into the category of the umbrella term of tendinopathy. This is the type of tendon pain that creeps up on you and then hurts with most activities and is really tough to settle.
KEYS TO TREATMENT
The key to treating tendinopathy is to have try and increase the capacity for the tendon to tolerate the load you are trying to put through it. In essence the treatment follows a plan of;
- Reduce pain – stopping the activities that cause too much load on the effected tendon is key. Changing activity and also resting postures, where relevant, that cause an increase in load is also essential to settling pain.
- Improve strength – gradually building up the strength of the effected is essential to increase the tendons capacity to tolerate activity. Building this strength up gradually and consistently is important to avoid flare ups.
- Build functional strength – Once the tendon and muscle unit are stronger and able to tolerate more loading it is then important to increase movement quality to avoid unnecessary strain on the tendon as you begin to return to normal activities.
- Sport / Activity Specific Retraining – In order to fully recover from any tendon problem, it is vital to regain strength and movement quality in the activity you wish to perform. Specific exercises to equip you for this are the last step in the process.
TIMEFRAMES FOR RECOVERY
Tendon problems can be troublesome and take a long time to fully recover. The steps of the treatment that we outlined above can take 2-3 weeks each. It is not uncommon for a tendinopathy to take 3 – 6 months for a full return to pre -njury levels.
Hopefully this background on tendons gives you a good overview of the current best practice for settling these problems down. Whilst the process is long and can seem complicated, working through each step and building on the foundations of strength and improving movement quality is the best treatment for common tendon complaints. As with most health conditions, every tendinopathy is different so get in to your friendly physio to start the rehab process now.